Published online April 3, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. 1113-1121 (doi:10.1542/peds.2005-1528)
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Prevalence of Spontaneous Closure of the Ductus Arteriosus in Neonates at a Birth Weight of 1000 Grams or Less

Josh Koch, MDa, Gaynelle Hensley, BSa, Lonnie Roy, PhDb, Shannon Brown, MDa, Claudio Ramaciotti, MDc and Charles R. Rosenfeld, MDa

a Department of Pediatrics, Divisions of Neonatal-Perinatal Medicine
c Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
b Department of Biostatistics, Children's Medical Center, Dallas, Texas

OBJECTIVE. Ductus arteriosus (DA) closure occurs within 96 hours in >95% of neonates >1500 g in birth weight (BW). The prevalence and postnatal age of spontaneous ductal closure in neonates ≤1000 g in BW (extremely low birth weight [ELBW] neonates) remain unclear, as does the incidence of failure to close with indomethacin. Therefore, we prospectively examined the prevalence, postnatal age, and clinical variables associated with spontaneous DA closure, occurrence of persistent patent DA, and indomethacin failure in ELBW neonates.

METHODS. Neonates delivered at Parkland Memorial Hospital from February 2001 through December 2003 were studied. Those with congenital heart defects or death <10 days postnatally were excluded. Echocardiograms were performed 48 to 72 hours postnatal and every 48 hours until 10 days postnatally.

RESULTS. We studied 122 neonates with BW of 794 ± 118 (SD) g and estimated gestational age (EGA) of 26 ± 2 weeks. Spontaneous permanent DA closure occurred in 42 (34%) neonates at 4.3 ± 2 days postnatally, with 100% closure by 8 days. These neonates were more mature, less likely to have received antenatal steroids or have hyaline membrane disease (HMD; 52% vs 79%), and more likely to be growth restricted (31% vs 5%) and delivered of hypertensive women. Using regression analysis, EGA and absence of antenatal steroids and HMD predicted ductal closure. Ten (8%) neonates with early DA closure reopened and required medical/surgical closure. Eighty neonates had persistent patent DA; 7 were surgically ligated, and 5 remained asymptomatic, with 4 of 5 closing after 10 days postnatally. Sixty-eight (85%) received indomethacin at 6.2 ± 4 days postnatally; 41% failed therapy and had no distinguishing characteristics.

CONCLUSIONS. Spontaneous permanent DA closure occurs in >34% of ELBW neonates and is predicted by variables related to maturation, for example, EGA and an absence of HMD, whereas indomethacin failure could not be predicated.

Key Words: gestational age • extremely low birth weight • indomethacin therapy • chronic lung disease • fluid therapy

Abbreviations: DA—ductus arteriosus • BW—birth weight • pPDA—persistent patent ductus arteriosus • EGA—estimated gestational age • HMD—hyaline membrane disease • ELBW—extremely low birth weight • PDA—patent ductus arteriosus • ECHO—echocardiogram • CLD—chronic lung disease • OR—odds ratio • CI—confidence interval • SGA—small for gestational age • AGA—appropriate for gestational age

Accepted Sep 28, 2005.




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